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General NPI Number Information
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NPI Number | 1164075990
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Entity Type | Organization
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Legal Business Name | FOREST CITY COUNSELING, LLC
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Dates
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Enumeration Date | 07/21/2019
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 6735 VISTAGREEN WAY STE 210
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City | ROCKFORD
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State | IL
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Zip | 61107-5654
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Country | US
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Telephone | 815-391-3055
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Fax | 815-904-6419
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Provider Business Mailing Address
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Address Line | 6735 VISTAGREEN WAY STE 210
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City | ROCKFORD
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State | IL
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Zip | 61107-5654
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Country | US
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Telephone | 815-391-3055
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Fax | 815-904-6419
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Authorized Official
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Title or Position | LCSW
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Name | JAN M SELANDER
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Credential | LCSW
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Telephone | 815-520-6972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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